Tobón A M, Franco L, Espinal D, Gómez I, Arango M, Trujillo H, Restrepo A
Corporación para Investigaciones Biológicas, Medellín, Colombia.
Pediatr Infect Dis J. 1996 Nov;15(11):1002-8. doi: 10.1097/00006454-199611000-00014.
To describe the clinical characteristics and laboratory diagnosis of seven children with disseminated histoplasmosis and evaluate the effectiveness of itraconazole therapy in this severe form of the mycosis as well as to determine the long term results of such treatment.
The diagnosis of histoplasmosis was based on the direct observation of Histoplasma capsulatum var. capsulatum and/or on the isolation of the fungus from pathologic materials; the results of the serologic tests were taken into consideration. Chest roentgenograms also contributed to the diagnosis.
The patients were seven rural children, five girls and two boys, ages 1 to 14 years (mean, 4.6), with a confirmed diagnosis of disseminated histoplasmosis and who had no underlying disease other than malnourishment.
The seven children experienced a subacute febrile syndrome for 4 months accompanied by anorexia, weight loss and signs of reticuloendothelial involvement such as lymph node hypertrophy, hepatomegaly and/or splenomegaly. The lung revealed roentgenographic alterations consisting mainly of nodular infiltrates. All patients received itraconazole orally in a mean dosage of 7.2 mg/kg/day, for variable periods (3 to 12 months), depending on the individual response and the toxic effects of the medication. One of the patients who was improving after 1 month of treatment was taken from the hospital by his guardian against medical advice and died shortly afterward. The remaining six patients responded to the treatment with marked clinical improvement and showed negative cultures and decreases in anti-H. capsulatum antibody titers after 3 months of treatment. Only one patient, the youngest and most severely affected child, exhibited hepatotoxicity, which subsided when itraconazole was discontinued. Extended follow-up studies revealed no relapses.
The results of this study indicate that itraconazole is effective for treatment of disseminated childhood histoplasmosis. More studies should be performed to determine the most appropriate dosage and the optimal duration of itraconazole treatment in children.
描述7例播散性组织胞浆菌病患儿的临床特征和实验室诊断方法，评估伊曲康唑治疗这种严重真菌病的疗效，并确定该治疗方法的长期效果。
组织胞浆菌病的诊断基于荚膜组织胞浆菌变种荚膜组织胞浆菌的直接观察和/或从病理材料中分离出该真菌；血清学检测结果也予以考虑。胸部X线片也有助于诊断。
7名农村儿童，5名女孩和2名男孩，年龄1至14岁（平均4.6岁），确诊为播散性组织胞浆菌病，除营养不良外无其他基础疾病。
7名儿童经历了4个月的亚急性发热综合征，伴有厌食、体重减轻以及网状内皮系统受累的体征，如淋巴结肿大、肝肿大和/或脾肿大。肺部X线显示主要为结节状浸润的改变。所有患者均口服伊曲康唑，平均剂量为7.2 mg/kg/天，疗程不等（3至12个月），具体取决于个体反应和药物的毒性作用。1名治疗1个月后病情好转的患者被其监护人违背医嘱带出医院，随后不久死亡。其余6名患者对治疗有明显临床改善反应，治疗3个月后培养结果转阴，抗荚膜组织胞浆菌抗体滴度下降。仅1名患者，即最年幼且病情最严重的患儿，出现肝毒性，停用伊曲康唑后肝毒性消退。延长随访研究未发现复发。
本研究结果表明伊曲康唑对治疗儿童播散性组织胞浆菌病有效。应进行更多研究以确定儿童伊曲康唑治疗的最适宜剂量和最佳疗程。
